dc.contributor.author | Cambridge, William A | |
dc.contributor.author | Fairfield, Cameron | |
dc.contributor.author | Powell, James J* | |
dc.contributor.author | Harrison, Ewen M. | |
dc.contributor.author | Søreide, Kjetil | |
dc.contributor.author | Wigmore, Stephen J | |
dc.contributor.author | Guest, Rachel Victoria | |
dc.date.accessioned | 2021-07-02T09:35:06Z | |
dc.date.available | 2021-07-02T09:35:06Z | |
dc.date.created | 2021-02-04T19:01:47Z | |
dc.date.issued | 2021 | |
dc.Published | Annals of Surgery. 2021, 273 (2), 240-250. | |
dc.identifier.issn | 0003-4932 | |
dc.identifier.uri | https://hdl.handle.net/11250/2763073 | |
dc.description.abstract | Objective:
To systematically review studies reporting survival data following neoadjuvant chemoradiation and orthotopic liver transplantation (NCR-OLT) for unresectable perihilar cholangiocarcinoma (pCC).
Background:
Despite survival improvements for other cancers, the prognosis of pCC remains dismal. Since publication of the Mayo protocol in 2000, increasing numbers of series globally are reporting outcomes after NCR-OLT.
Methods:
MEDLINE, EMBASE, Scopus, and Web of Science databases were searched from January 2000 to February 2019. A meta-analysis of proportions was conducted, pooling 1, 3-, and 5-year overall survival and recurrence rates following NCR-OLT across centers. Per protocol and intention to treat data were interrogated. Meta-regression was used to evaluate PSC as a confounder affecting survival.
Results:
Twenty studies comprising 428 patients were eligible for analysis. No RCTs were retrieved; the majority of studies were noncomparative cohort studies. The pooled 1, 3-, and 5-year overall survival rates following OLT without neoadjuvant therapy were 71.2% (95% CI 62.2%–79.4%), 48.0% (95% CI 35.0%–60.9%), and 31.6% (95% CI 23.1%–40.7%). These improved to 82.8% (95% CI 73.0%–90.8%), 65.5% (95% CI 48.7%–80.5%), and 65.1% (95% CI 55.1%–74.5%) if neoadjuvant chemoradiation was completed. Pooled recurrence after 3 years was 24.1% (95% CI 17.9%–30.9%) with neoadjuvant chemoradiation, 51.7% (95% CI 33.8%–69.4%) without.
Conclusions:
In unresectable pCC, NCR-OLT confers long-term survival in highly selected patients able to complete neoadjuvant chemoradiation followed by transplantation. PSC patients appear to have the most favorable outcomes. A high recurrence rate is of concern when considering extending national graft selection policy to pCC. | en_US |
dc.language.iso | eng | en_US |
dc.publisher | Wolters Kluwer | en_US |
dc.rights | Navngivelse-Ikkekommersiell 4.0 Internasjonal | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc/4.0/deed.no | * |
dc.title | Meta-analysis and Meta-regression of Survival After Liver Transplantation for Unresectable Perihilar Cholangiocarcinoma | en_US |
dc.type | Journal article | en_US |
dc.type | Peer reviewed | en_US |
dc.description.version | publishedVersion | en_US |
dc.rights.holder | Copyright 2020 The Authors | en_US |
cristin.ispublished | true | |
cristin.fulltext | original | |
cristin.qualitycode | 2 | |
dc.identifier.doi | 10.1097/SLA.0000000000003801 | |
dc.identifier.cristin | 1886915 | |
dc.source.journal | Annals of Surgery | en_US |
dc.source.40 | 273 | |
dc.source.14 | 2 | |
dc.source.pagenumber | 240-250 | en_US |
dc.identifier.citation | Annals of Surgery. 2021, 273(2), 240-250 | en_US |
dc.source.volume | 273 | en_US |
dc.source.issue | 2 | en_US |